Tag: upper lip lift

It would be easy to assume that the changes to Sophie Monk’s face over the years were the result of surgical intervention. According to Beverly Hills plastic surgeon Dr. Randal Haworth, she has not actually gone under the knife. ‘It is human nature for people to jump to conclusions when a celebrity has even the slightest change in appearance. Suspicions and speculations about plastic surgery run wild and I believe Sophie Monk is among the accused!’ the CEO of DrHaworth.com told Daily Mail Australia on Tuesday.

Dr. Haworth stated: ‘Though critics have insisted she had a rhinoplasty or brow lift, I believe she may not have had actual surgery at all. Instead, I sense she took full advantage of some non-surgical cosmetic options. For example, the fact that her forehead is smooth and devoid of normal wrinkles while her outside eyebrows are now higher indicates she was treated with Botox. When applied selectively, Botox not only minimizes wrinkles but can also lift certain facial features such as the eyebrow and the corner of the lips.’ He also turned his attention to Sophie’s plump lips, absence of hollowing under her eyes and prominent cheeks – all signs of non-surgical intervention.

Sophie, who hails from Queensland’s Gold Coast, has admitted to having filler to her top lip in the past, following the botched removal of a cyst. ‘Half of my lip was removed with the cyst, and I was advised to get filler in my top lip to help balance it out,’ she told Who magazine in early 2011.

Many social media influencers enlist the help of photo editing apps to sharpen up their picture-perfect public image. Beverly Hills plastic surgeon Dr. Randal Haworth believes that Tammy Hembrow may also rely on cosmetic procedures. According to Dr. Haworth, she may have undergone a nose job, liposuction and dermal fillers to achieve her bombshell look. ‘Miss Hembrow is the quintessential Instagram model for our social media world where fake is the new real,’ Dr. Haworth said.

The celebrity plastic surgeon went on to claim that she strikingly different in recent photos compared to images of her taken several years ago. ‘Based on what I presume to be filtered photos, she has undergone a striking transformation of not only her facial features but also of her facial shape,’ Dr. Haworth claimed. ‘Her jawline is more defined into a “V-line”. I would even venture to say her chin has been shortened and narrowed compared to her teenage years.’ says Dr. Haworth.

According to Dr. Haworth, Tammy Hembrow’s lips have also almost certainly been enhanced due to their ‘overly plumped’ appearance. He claimed: ‘Like Kylie Jenner, Tammy has been originally inspired by the Angelina Jolie lip variety. Paradoxically, lips oversized for a face can mature the visage beyond its years.’ His claims come after Tammy was stretchered out of Kylie Jenner’s 21st birthday party at celebrity hotspot Delilah in West Hollywood last Thursday night.

Very few surgeons in the world understand aesthetics to the point where they can be a true hyperaesthetic facial plastic surgeon specialist. A hyperesthetic specialist is similar to the conductor of an orchestra-he or she needs to know all the instruments better than the individual players in order to “orchestrate” them to create melodious harmony without dissonance. One of the keys to create visual harmony in the face is mastering lip rejuvenation surgery-it’s not just about adding volume (which is essentially what most practitioners and patients equate with lip enhancement), it’s about mastering the shape of both the upper and lower lip. Patients travel from all corners of the globe to top Beverly Hills plastic surgeon and lip augmentation specialist, Dr Haworth to undergo hyperesthetic change, which may include any number of surgical art performances including a high-profile facelift, endoscopic brow lift, blepharoplasty, rhinoplasty or his lip reshaping signature surgery! https://youtu.be/cI3nEq5R3x8

By trade-offs I am referring to subtle and sometimes significant alterations in your appearance that will be incurred by undergoing a certain plastic surgical procedure. It is the doctor’s responsibility to inform the patient of these trade-offs (including risks of complications) while it is the patient’s responsibility to make an informed decision to proceed if he or she feels that the benefits of the surgery will outweigh the risks and trade-offs.

Examples of such trade-offs are the scars in and around the ear that result from a facelift. Even though they may be near invisible, they are scars nonetheless. The majority of patients feel that benefits of the facelift outweighed any of the associated trade-offs. Similarly, patients who undergo an abdominoplasty (tummy tuck), mastopexy (breast lift) or brachioplasty (arm lift) should be fully aware that they will develop scars from those procedures. Though the majority will heal well with very acceptable scars, most of the time the scars will be visible to some degree.

Patients who undergo a rhinoplasty must understand that their nose will be numb, stiff and hard for up to 3 months or more while swelling can persist for 1 to 2 years. Numbness from a facelift or a browlift can last many months as well. Despite understanding these trade-offs, the vast majority of patients have no problem undergoing these procedures once they have decided to do so.

Over the years, I have found it curious that a small minority of patients undergoing lip reshaping surgery in the form of upper lip lifts and V-Y plasties had unrealistic expectations in terms of their healing and results. They were surprised even angry that they experienced numbness, stiffness and associated scarring. Sometimes a very subtle change in the nostril position occurred after the surgery. These trade-offs may arise even though the result of the upper lip lift is successful from the aesthetic standpoint-in other words, the net benefit in the sensual-youthful-beauty quotient for the face has been increased. However, a few may consider the lip lift a failure if they have experienced even a slight degree in any of these trade-offs.

Though these trade-offs can mostly be successfully reversed, a patient should not elect to undergo such a procedure if he or she will not accept that these can be normal aspects of the procedure. If one thinks about it, an upper lip lift will have its trade-offs in the same way other procedures would have their own yet it perhaps gets more attention than other anatomical features of the face because the lips are expected to not only look beautiful but also function as well.

And function they do, more than any other part of the face. Indeed, lips are used to express, emote, eat, kiss and speak-essentially they move millions of times a day! Because of these strong repetitive muscle forces around the nasal and oral region the plastic surgeon must create a strong upper lip lift that will resist these forces in order to achieve a result that is long-lasting, with minimal scarring and nasal distortion.

In fact, lip shaping procedures are the most challenging of all facial plastic surgeries, even rhinoplasties. Though the success of facelifts are measured in centimeters, brow lifts in increments of 2 to 4 mm and rhinoplasties in millimeters, lip reshaping surgery is measured in quarter-to-an-eighth of a millimeter! With those scales, one can almost consider this close to microsurgery.

In 2014, it would be a miracle to undergo an upper lip lift with an unequivocal guarantee of no scarring, nasal distortion, prolonged minor sensory changes and stiffness. If you are contemplating undergoing an upper lip lift but will not tolerate any of these tradeoffs, I suggest you avoid the procedure altogether and wait for that miracle to happen.

Patients often asked me what are the differences between a skin-only lip lift and my muscle hemming technique. To put it simply, longevity, scarring and nasal distortion.

Skin Only Lip Lift

Until the late 90’s, the only lip lift I knew how to do was the skin only type. I would perform this by excising a certain amount of skin below the nasal base and sewing the lower edge of the excision to the upper edge which happens to be the skin of the nose. The only thing now supporting this entire weight of the upper lip (which happens to move millions of times a day, eating, kissing, expressing and speaking) is the freshly closed incision at the skin level. One can imagine that this provides little support for all the action occurring around the upper mouth area. Consequently, the longevity of the lip lift itself is lessened, the nostrils are more likely to be pulled downwards while the resulting scar is more likely to stretch and thicken.

The results of a skin-only lip lift. Notice the widened scars, significant nostril distortion and recurrent long upper lip.

Muscle Hemming Lip Lift

After many years of observing the long-term results of skin-only lip lifts, I developed the muscle hemming technique. By employing moderate principles of plastic surgery in which nip and tucks (such as a facelift) are improved by lifting and tightening the layers below the skin including muscle I have noted a significant benefit to my lip lifts in terms of scarring, longevity and less nasal distortion. However, the recovery period was notably increased. The muscle hemming technique involves placing slowly dissolvable sutures into the muscle layer below the skin and intern suturing that to the periosteum (lining) of the bone deep to the nose itself. The lip lift is thus a solid one without relying on skin closure to achieve its superior long-term results while lessening the chance of undesirable scarring and pulling around the nostrils.

Skin Flap Lip Lift

Which brings me to today. For the last 3 years I have been employing a skin-flap technique which provides all the benefits of the muscle hemming technique but with half the recovery. Suturing of the muscle is minimized in this technique but none of the longevity and superior scarring is sacrificed. The period of significant distortion and swelling has been halved from 2 weeks to less than 1. Additionally, the results are “softer” in appearance with minimal to no distortion of the nostril area.

Patient with subliminal long upper lip with minimal upper tooth showAfter skin -flap lip lift by Dr. Haworth of Beverly Hills. Notice significant increase in tooth show and natural shortening of the upper lip with minimal nasal distortion. Being a lip lift expert, he developed this surgery to further his evolutionary journey into perfecting the ideal upper lip lift. This new technique also produces softer results those from the skin-only and muscle-hemming techniques.

Performing the modern lip lift with minimal-to-no-scarring and achieving a permanent beautiful result is challenging . It requires attention to minute detail and appreciation of how the oral region plays a central role in facial harmony. The vast majority of patients are thrilled with the subtle yet powerful results of this operation, but it has taken over 2 decades of unwavering dedication and imagination to get this far.

As one of the leading rhinoplasty specialists in the United States, Dr. Randal Haworth continues to challenge himself to be the best he can be. By constantly questioning his results and asking himself how he can do things better, he feels he is subjecting himself to the highest quality assurance and delivering the best possible outcomes in plastic surgery .

Performing rhinoplasties are one of my favorite specialty since the nose place such a central role in the total harmony of the face. Consider it like one of the leading instruments in the orchestra. Though most plastic surgeons and patients alike obsess on nasal humps, wide bones as well as drooping, boxy, pinched and ill-defined tips and, of course, the width of the nostrils, little attention is paid to the actual shape of the nostrils. In other words, a surgeon should not only assess whether the nostrils are wide at their base, but also whether they are arched, pointy, thick or sigmoid in shape.

One of the most common and unflattering nostril shape is that of the “samurai nostril”. Look at the following two photographs and you will see what I mean.
Another example of these flared nostrils that may look appropriate as a menacing sign but not a flattering one for beautiful womanA samurai mask manifesting the flared, aggressive shaped nostrils that are unappealing in a woman

There are a few ways to correct this but probably the most reliable is to harvest a “composite” graft from the hidden portion of one’s ear. This detailed surgery involves insinuating this graft between an incision made on the inside of the nose, corresponding to the actual width of the retracted portion of the nostril. This graft is then sutured into place with the skin side facing the actual inside of the nostril to maintain the continuity of it’s lining. One can lower the nostril about 3 to 4 mm with this technique. Of course, some resorption of the graft occurs so it is best to over-correct this.

Other techniques involve strategic V-Y plasties, which are essentially internal tissue rearrangements of the inner aspect of the nostril in order to lower its rim, cartilage grafts in the actual substance of the nostril to help correct pinched tips while lowering the rim and, finally, filler. These latter techniques, though successful to some degree, are not as effective as an ear “composite” graft.

Note the following two cases in which “composite” grafts were taken from the ear and placed within the nostril to lower them. Of note, simultaneous upper lip lifts to further enhance a feminine appearance were performed.

Transgender patient was retracted nostrils, long upper lip and droopy corners of the lip

Dr. HAWORTH performed a modified rhinoplasty by lowering the nasal arched “samurai” rims (nostrils) as well as an upper lip lift and DAO release to lift up the droopy corners of the mouth

Patient with a long upper lip and retracted “Samurai”nostrils after a previous rhinoplasty by another surgeon

Dr. Haworth performed an upper lip lift along with nostril rim lowering via a composite graft from the ear. Fat transfer was also performed into the upper and lower lips. Notice the more feminine harmony

While many surgeons feel uncomfortable with performing an upper lip lift, let alone one simultaneously with a rhinoplasty, it can be safely done. The concern revolves around the fear of losing vital blood supply to the columella (the fleshy straight partition that exists between the nostrils), because if the blood flow is compromised to this area then necrosis or loss of the columellar skin can result. This, in turn, can lead to a possible unsightly scar. If the nose job is performed through an endonasal or closed approach ( whereby all incisions are strictly confined to within the nose itself) there should be little concern for this. However, caution must be exerted when the rhinoplasty is performed with an open technique- one that involves making a scar across the columella in order to gain better access and therefore better visualization and control of the operation. In a normal open technique the incision is placed about halfway up on the columella. Since an upper lip lift necessitates making an incision at the base of the columella (where it joins with the upper lip), the incision needed for the open rhinoplasty can also be the same one- so the incision will be used for two different purposes.

Scar placement for rhinoplasty alone and in combination with an upper lip lift

The situation becomes more complicated, however, when a persisting scar stemming from a previous open nose job is present. In this situation, the plastic surgeon must carefully plan his incisions so as not to compromise the blood supply. More often than not it is safer to keep the upper lip lift incision separate from the rhinoplasty’s in these revision cases.
The planning becomes even more critical when the nostrils need to be narrowed during the nasal aesthetic surgery ( Weir excisions). Not only does the upper lip lift need to be blended well onto the columella, but it also needs to be conformed to a freshly narrowed nasal base, with minimal undesired tension across the final scar ( which can increase the chance of it being noticeable). Intricate surgery along with an intimate knowledge of the regional anatomy and the biophysics of an upper lip lift are key ingredients to a beautiful outcome in this combination surgery. Following are two examples of before and afters of this combo surgery.